This article discusses differences between lending to the health care industry and to other, more traditional industries then looks at strategies for tapping into the significant revenue in the medical markets.

Facilitating local economic growth is a commonsense goal for banks. Key industries vary by market, but one industry must exist for any market to attract new businesses and consumers–health care. As this industry grows increasingly complex and risky, banks across the U.S. are looking for creative ways to meet its unique needs.

Most bankers think of local physician groups or hospitals in terms of core deposit relationships–and for good reason. Medical providers are typically a key source of both deposit and investment opportunity As these organizations grow however, they also have significant credit needs, both for facility expansion and for working capital. Over the years, banks have struggled with the risk/reward equation for different facets of the health care industry. The solution begins with understanding the customer.

Young and emerging medical organizations can grow quickly into large providers of various medical services. Population growth in key urban areas along with an aging population have fueled dramatic growth in just about all fields of medical service. These growing organizations need access to cash more than ever, especially during the first five years of operation. Many bankers have a real appreciation of the unique characteristics of this market because they have attempted to provide more than term note options. Some key distinguishing factors that set medical risk apart from traditional industry risk are as follows:

* Billing/claims submission to multiple guarantors.

* Claims that are subject to multiple adjustments “after” the bank has advanced the funds.

* Involvement of third-party payers, including insurance and government agencies.

* Involvement of federal agencies and the regulatory impact on the industry.

* Contractual allowances made between parties.

* Complex coding and billing procedures.

* A/R turns that often exceed 100 days as a normal course of business, whereas most other industries turn in fewer than 50 days.

* Third-party reviews of utilization and coding that could cause the provider to fail.

* The requirement for credentialing and state licensing.

* Intricacies of the aging report, such as gross-versus-net billing and “‘unbilled services.”

A new dental clinic now operational for almost two months at Fort Stewart, Georgia is facilitating the dental processing of soldiers mobilizing in support of Operations Noble Eagle and Enduring Freedom. Dental Clinic #7 is collocated with the Soldier Readiness Processing Center (SRP), allowing a one-stop shop for all Soldier Readiness Check (SRC) requirements. For the first time in the history of Fort Stewart, a digital radiography system has been implemented to expedite the processing of panoramic X-rays for the mobilizing soldiers. The Fort Stewart dental assistants are receiving incredible experience as they open the new clinic and implement the new digital radiography technology.

The staffing of the dental assistant team at the clinic consists of four Active Duty and five Army Reserve soldiers who have recently been called to active duty. Upon activation, the soldiers of the 7224th Medical Support Unit were fully integrated into the Fort Stewart Dental Activity (DENTAC) team and have made a tremendous impact on the efficiency of the mobilization operations. SPC Powell of the 7224th stated that, “The active duty dental assistants have been working as a team and have been very helpful in orienting us to the active Army side of life.” SGT Edwards, who serves as a dental assistant and X-ray technician at the site, feels that the DENTAC has greatly benefited from the augmentation. He has been extremely impressed with the speed and quality of dental care afforded to the mobilizing soldiers.

Under the direction of SSG Adrian Tucker, the Noncommissioned Officer-In-Charge of the clinic, all of the dental assistants are given the opportunity to work in multiple facets of the dental SRC process. All of the assistants received initial training on the operation and capabilities of the new direct digital X-ray equipment. As the subject matter expert, SSG Tucker initially provided on-the-job training to all dental assistants and dentists. Now after almost two months of experience, members of the regular clinic staff have the capability to train any newcomers on the digital radiography procedures.

The process flow for the SRP site is initiated with a briefing for all mobilizing soldiers. The mobilizing soldiers are instructed in the proper method of completing and updating their dental record and medical history form. It takes approximately 5-7 minutes to complete the dental portion of the SRC briefing. 110-120 personnel are briefed at one time.

Meeting in March in Chicago, the ADAA Board of Trustees discussed what ADAA members could do for our fellow U.S. Army dental assistants. Because of ADAA’s contractual relationship with the Army, a donation of money or materials on an institutional level is not permissible, however, individual members may take actions that will be appreciated by army assistants.

Letters, cards and AT&T phone cards (no packages please) would be appreciated by Army dental assisting personnel. These can be sent do First Sergeant Scott who is in charge of the 561st Medical/Dental Company and c/o First Sergeant Hoffman who is in charge of the 502nd Medical Company serving in Iraq and will be in charge of giving letters and cards to the soldiers.

Since these are U.S. addresses with a zip code, no postage other than normal U.S. postage is required.

SGM Stephen Spadaro also asks that we remind everyone that many of these soldiers are young and very lonely away from home, so correspondence should be kept on a professional level. We welcome ADAA membership participation in this worthwhile “Operation.”

Objective: Dental Readiness Training Exercises (DENRETEs) are the military form of dental humanitarian missions. Most dental humanitarian missions focus on extractions and the provision of oral hygiene instructions. This paper describes a dental humanitarian mission, sponsored by the US Army Dental Command (DENCOM), to Honduras in 2003 and how expanded function dental assistants can increase the provision of dental care. Materials & Methods: The US Army Southern Command requested a DENRETE for fiscal year 2003. A site visit revealed the absence of water fluoridation, high levels of dental disease, and a desire to have an American dental team perform the mission at the Escuela Lempira, a low-income elementary school in the Honduran capital city of Tegucigalpa. Results: DENCOM in conjunction with dental personnel performing a 6-month rotation with Joint Task Force Bravo performed a Pediatric Humanitarian mission in Tegucigalpa from 1 to 9 April 2003. During 6.5 treatment days, there were 416 patient encounters totaling 1490 treatment procedures. Over $90,000 in dental services were provided.

Conclusions: The 2003 Honduran DENRETE represented a changing paradigm from extraction-based dental missions toward providing comprehensive care aided by maximizing the use of dental assistants trained in expanded functions. With this philosophical shift in focused care, dental humanitarian missions have the ability to enhance the oral health of more children.

INTRODUCTION

Dental Readiness Training Exercises (DENRETEs) are the military version of humanitarian and civic assistance projects. DENRETEs provide military members with realistic training, facilitate access to healthcare for traditionally underserved populations, and provide an opportunity for professional exchange. This fostering of international cooperation between the U.S. Government and those countries being served promotes a favorable view of the United States. These missions also give military members an opportunity to use their professional skills in a deployed environment to help those less fortunate.

Dental officers and technicians must have reliable, durable, well-performing field dental equipment to enable them to provide dental care to deployed troops in operational environments. Unfortunately, no organized program exists to test such equipment before its purchase and use in the field. This article presents the results of a project conducted by the Naval Institute for Dental and Biomedical Research and the Air Force Dental Evaluation and Consultation Service to evaluate commercially available field dental equipment through laboratory testing and clinical-user evaluations in theater. The purpose of this 2-year project was to identify the best-performing and most cost-effective field dental equipment for possible future procurement. Initial laboratory testing was performed at the Naval Institute for Dental and Biomedical Research, and the equipment was then shipped to Kuwait for in-theater environmental and clinical-user testing. A seven-member scientific team of military dental officers and technicians was deployed for 1 month to perform in-theater testing under regional environmental conditions and to coordinate clinical-user evaluations. The testing provided beneficial results by identifying equipment that performed properly and equipment that exhibited shortcomings serious enough to render it inadequate for operational use. It is recommended that the project serve as a model for future testing and evaluation of medical/dental equipment by all of the military services.

Military experience clearly shows that dental casualties occur in all deployment venues. Published epidemiological studies have determined that dental casualties constitute 10 to 22% of all emergency health visits during conflicts, deployments, and field training exercises.1,2 This equates to an annual rate of approximately 150 to 200 cases per 1,000 troops.3-7 Nearly 50% of the emergencies are related to fractured teeth, lost dental restorations (fillings), and loose crowns and bridges,8 which can easily be treated by a dental officer. Unfortunately, even deploying a dentally fit force does not prevent dental problems such as these from arising.

Direct reimbursement plans may’ cause fewer hassles for employers.

How can six months go by so quickly? It’s already time for another visit to your dentist - not one of your favorite things to do. But some companies are making dental care a little less painful with a new type of low-hassle benefit plan.

Most companies offer their employees dental plans - 93 percent of employers responding to a 1997 survey by William M. Mercer Inc. Fifty-six percent offered dental coverage as a standard benefit, while 37 percent offered it as an optional benefit.

The most common type of plan (86 percent) was the traditional fee-for-service; 29 percent offered a managed care plan in addition to the traditional one.

But more companies are turning to direct reimbursement dental plans, which offer employers and employees alike advantages of speed and simplicity.

The New Plan in Town

At the time of the Mercer survey, direct reimbursement dental plans had not really caught on. Although they were devised in the 1970s, it wasn’t until 1996 that the American Dental Association (ADA) and dental societies began promoting them, according to Thomas Killam manager of the ADA’s Council of Dental Benefit Programs.

This new push has come at the request of the ADA’s membership - dentists. “We had been promoting it through dentists and having them talk to their patients about it,” Killam notes. “That was fine, except that dentists aren’t the best salespeople in the world, and it seemed a bit self-serving. So, we decided to do a more business-to-business type promotion, reaching out to decision-makers at companies on a corporate level.”

Administrative Cost of Dental Plans

HMO                             27% of total cost

PPO                             19

Traditional Plan                18

Direct Reimbursement Plan     5-10(*)

* Amount depends on the size of the company and whether the plan

is administered in-house or by a third-party administrator.

Source: The American Dental Association

Killam says the ADA knows of at least 2,100 U.S. companies offering direct reimbursement plans to their employees. “Actually, we know that there are a lot more than that, because the program is very conducive to self-administer, but there is no requirement to report the statistics.”

Los Angeles, Las Vegas, Salt Lake City, and San Diego recently joined the majority of fluoridated American cities. It took longer to sell the story to the West. More than 70 percent of our nation’s drinking water is medicated to treat the teeth, according to figures released by the U.S. Census Bureau.

Fluoridation, in case your dentist has not drilled it into your head by now, is the process of adding sodium fluoride (NaF) to municipal drinking water. It is nothing new; there is a 50-year history of fluoridation in the U.S.

Fluoride is a binary compound of fluorine with another element. Sodium fluoride is routinely used as an insecticide and as a rodenticide. Although the compound is almost synonymous with rat poison, it represents something else to dentists and most health care advocates. Fluoride is the otherwise disposable by-product of the manufacturing process, and the suppliers of the product are the aluminum and phosphate fertilizer companies.

As early as 1940, Dr. Gerald Cox of the Mellon Institute was aggressively promoting the addition of fluoride to public water systems to reduce tooth decay. The Mellon family, interestingly, owned the Aluminum Company of America (ALCOA), which proceeded to sell fluoride to the municipalities. In the face of the pressure, the American Dental Association (ADA) warned in the Journal of the American Dental Association (October 1, 1944) that

even minuscule amounts of fluoride will cause osteosclerosis,
spondylosis, osteopetrosis, and goiter, and we cannot afford to
run the risk of producing such serious systemic disturbances in
applying what is a doubtful procedure to prevent dental
disfigurements among children. The potentialities for harm far
outweigh those for good.

Three months after issuing its strong warning, the ADA was promoting and participating in the fluoridation projects. The ADA has maintained its continuous support of legislation to fluoridate drinking water.

Maybe fluoride causes truth decay.

Fluoridation programs are usually implemented by independent municipal choice, although a few states make it mandatory. Indianapolis was the first major city to fluoridate drinking water in 1951. The treatment of drinking water with the precise amounts of fluoride is supposed to prevent dental caries in children, but the record is dubious.

ADAA offers a record number of new and revised courses in our roster of home study opportunities.

Just look at the list presented here and see the six new courses and then check out the revised courses as well–there are five!

If you haven’t received your current copy of the Professional Development Catalog from ADAA’s Continuing Education Council, you’ll want to order one right away. Call, write, fax or drop us an e-mail.

And there are other good ideas for professional growth too. You can get a package of materials to prepare for all three national exam topics–chairside, infection control and radiation–and you can order ADAA’s popular career video “Your Future in Dental Assisting,” a 7-minute capsule to aid in career planning presentations.

Newly Revised Courses:

* Dental Assistant’s Management of Medical Emergencies

* Alginate Impressions and Diagnostic Study Model Techniques

* Prevention of Disease Transmission in the Dental Office

* Introduction to Computerized Dental Systems

* Designing a Comprehensive Health History

Package Pricing:

Purchase all three national exam prep courses and save:

#0109 (Chairside)

#0008 (Infection Control)

#9806 (Radiology)

If bought separately, cost $205; as a package, only $150; Non-member: $225.

With the focus of the world on the U.S. military, it is more than coincidental that this year’s DARW entries included more military input than ever before. An entire category in the competition was created and identified as “Other Organizations” and included both Army and Air Force entries and will in the future feature the work of dental associations, government agencies such as Veterans Administration clinics and any other large institutional practice not included in the traditional groupings of schools, dental assisting associations and dental offices.

We are pleased to acknowledge the enthusiasm of this sector of participants and welcome them along with the new and returning entries from all other categories.

As usual, in addition to thanking the entrants, we are grateful to the panel of judges from the ADAA and the ADA who gave their time to the review and selection of materials. The competition covered in this issue reflects only the work of U.S. individuals and groups, with the Canadian groups conducting their own competition.

A note about the headline. DARW themes are chosen by joint action of the sponsors of the event: the American Dental Association, the American Dental Assistants Association, The Canadian Dental Assistants’ Association and the Canadian Dental Association. The theme is generally retained for three or four years. The outgoing theme, “United by Excellence, Linked by Pride,” was in effect from 2000 through this year, 2003.

The new theme that will take effect for the 2004 Week is based on an idea from Nancy Callaway of Overland Park, KS, an ADAA member. Ms. Callaway will receive one year’s free national dues from the ADAA. We thank everyone who provided input and ideas for this project.

Remember how the dentist was always nagging you to brush your teeth twice a day? If the promise of fewer cavities, healthier gums and a brighter smile aren’t enough incentive, sink your teeth into this: The way you take care of your teeth and gums may have an impact on your overall health. Some researchers suggest that there may be a link between gum disease and systemic diseases such as diabetes, high blood pressure and heart disease–health challenges that are prevalent among African-Americans. Even low-birth-weight babies may be associated with periodontitis.

WATCH YOUR MOUTH

“I can’t stress enough the important role good dental hygiene plays in overall health,” says Hazel J. Harper, D.D.S., MP.H., and a past president of the National Dental Association, the world’s largest organization of minority oral health professionals (www.ndaonline.org). “The mouth is connected to the rest of the body. If the mouth isn’t healthy, the body cannot be healthy.” Plaque–the sticky film of bacteria that forms on teeth is most often the cause of gum disease. If it is not removed with thorough daily brushing and cleaning, gums can become irritated, eventually separating from teeth and leaving tiny spaces that can fill with bacteria. If left untreated, gum disease may destroy the bone and other tooth-supporting tissues.

Start now to improve your oral hygiene habits. The American Dental Association (www.ada.org) has established a basic regimen that will help you keep your teeth and gums healthy:

* Brush your teeth at least twice a day (brushing after every meal is ideal) with a toothpaste that contains fluoride.

* Floss once a day.

* Have a dental checkup twice a year. Dr. Harper suggests that patients who may be at high risk for gum disease those with diabetes, high blood pressure and heart disease, or people on prescription drugs with dry mouth as a side effect–see their dental practitioner four times a year for better dental health.

* Limit snacking between meals, and keep beverages and foods high in sugar to a minimum.

The Latest Innovation In Oral Care

Everyone wants a healthy, glistering, radiator smile–but your everyday brushing routine may not be enough. Acids from foods and beverages, including carbonated drinks and coffee, can erode the outer mineral layer of teeth, creating tiny uneven crevices that collect plaque and stains. The result teeth that look dull stained and yellow.